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Case Study

Hospital Disinfection - Assessment for Government

The Client

The UK Department of Health

The Problem

Recent reports have focussed on the fundamental need for
effective hospital cleaning regimes across all hospital facilities.
Audits by the Healthcare Commission have identified that standards
of cleanliness in some hospitals could be improved. In addition,
DH-NHS Estates Revised Guidance on Cleaning (2004) has acknowledged
that, as a result of Trust budgetary constraints, cleaning
standards 'were vulnerable to being driven down over an
extended period until, in some cases, they reached unacceptable
levels'. This may be of particular importance in the spread of
MRSA and other antibiotic resistant microorganisms within the
hospital environment, either by contact or dust deposition.

It is possible that technologies exist, which could contribute
to an improvement in hygiene standards within the hospital ward
environment. This study was tasked with assessing existing (wet)
disinfection methods, as well as those that might be more widely
used, should their efficacy be confirmed.

What We Did

A
major study was undertaken to assess the effectiveness of existing
wet surface cleaning methods in controlling the spread of MRSA and
other microorganism within the ward environment. Hospital work was
undertaken in partnership with clinical scientists in a large West
Midlands Trust, and recontamination of solid ward surfaces and the
presence of bioaerosols in ward air were included in the sampling
regime. Observations of physical activity on the ward, which might
contribute to microbiological findings, were also made in order to
link these aspects of the ward environment.

HSL was also asked to evaluate commercially available vaporised
hydrogen peroxide (VHP) and ozone fumigation technologies; work was
initially undertaken in a 'mock' side room facility created in
HSL's Controlled Air Chamber (CAC). Latterly, the same machines
were applied to a real hospital side room environment in order to
assess their usability and efficacy in a front line hospital
situation. Because fumigation applications may offer an additional
method of disinfection for ward 'deep cleaning' regimes or during
outbreaks, the agreed suite of target organisms used in the CAC
tests included pathogens such as MRSA, Clostridium
difficile and Influenza virus.

Outcome/Benefits

Data from HSL chamber tests have allowed us to make extensive
interpretation on efficacy, usability and health and safety, when
operating a range of fumigation machines. Data were obtained across
four seasons for hard surface and airborne contamination levels on
a busy MRSA cohort ward, and the re-colonization and observational
data obtained provided an insight in to the efficacy of traditional
cleaning and whether its benefits persisted.

It is likely that hygiene Policy decisions within the Department
of Health may be influenced by the findings of this study, and
these, in turn, may affect the future uptake of fumigation
technologies within the health care sector.